Hormonal Breast Pain
70% of people with breasts experience breast pain [also referred to as mastalgia] at some point (1). Breast pain can be divided into two types: cyclical breast pain, which is linked to the menstrual cycle (2) and hormones, and noncyclic breast pain, which isn’t linked to the menstrual cycle (2). For the sake of this article, we’ll be focusing on breast pain thanks to the menstrual cycle.
So, What Causes Hormonal Breast Pain?
Throughout the menstrual cycle, hormone levels and ratios fluctuate (read more about how the cycle works here!) Two key hormones in the menstrual cycle are estrogen and progesterone, and it’s the ups and downs of these hormones that can cause your breasts to feel painful, lumpy and swollen (3). Why the pain? The sensation you are feeling is the stimulation of your duct and milk glands- they are increasing in size and number in case lactation may become necessary (4). (Turns out the cervix and cervical fluid aren’t the only things that change throughout the cycle!) This makes the breasts swell and retain water (5). Hence the pain and tenderness you feel. While the sensations may be different for everyone, oftentimes the discomfort intensifies during the two weeks leading up to the start of the bleeding phase, with the peak of discomfort occurring three to five days before the bleeding phase begins (6). Oftentimes the pain begins to lessen when the bleeding phase (aka your period) ends (3, 7).
It is common to feel the discomfort in both breasts (although it doesn’t have to), and can spread to the armpit (8), since you have breast tissue there too! Cyclical breast pain is more likely to affect people who menstruate who are of reproductive age.
Fibrocystic Breast Changes
While your period may be the culprit, your hormonal breast pain may be exacerbated due to something called fibrocystic breast changes. (It’s not as bad as it sounds!) To understand what is it, let’s break down the anatomy of the breast.
Breasts are comprised of glands, which is where milk is produced, and ducts, which are tubes which transport the milk to the nipple (9). Surrounding the glands (9) you have something called fibrous support tissue. Sometimes, the fibrous support tissue thickens (10) causing it to feel firm, ropey, or rubbery. This thickened tissue is called fibrotic tissue. Sometimes, in addition to this thickening, milk glands (10) can fill with fluid (yum!) causing cysts. Cysts can move around your breasts, and the amount of fluid inside of them can change. More fluid = more stretched tissue = more discomfort. Hello, fibrocystic breast changes! The exact cause for fibrocystic breast changes aren’t known, but it is thought to be connected to fluctuating hormones, especially estrogen (11).
But don’t fear! Fibrocystic breast changes happen to about half of AFAB (assigned female at birth) in their 20s-50s (7) and is generally not dangerous- just uncomfortable (and can sometimes cause nipple discharge) (10). If you experience fibrocystic breast changes, symptoms are often worse just before your period. Typically, no treatment is necessary unless your symptoms are particularly persistent and causing issues with your daily life (although always check in with your health team if you’re unsure).
how do you know if your breast pain is hormonal?
Track it, baby! Cycle tracking is an awesome way to better understand your unique body. Because oftentimes the breasts are left out of the period convo, you may need to create your own section in the tracker to make a note of how your breasts feel over time. After a handful of cycles, there might be a clear pattern like, ohhh my boobs KILL because I’m about to ovulate.
Okay. So you’ve tracked your symptoms, and yes, those painful boobs are because of your menstrual cycle. What’s a menstrator to do?
things to help
- Breast support. Supporting the breasts when you’re experiencing cyclical breast pain has shown to give some relief. (Help a sister out!) Find a good, supportive, bra and see if that helps (6, 3)!
- Anti-inflammatory painkillers. Duh.
- Cutting out the caffeine (6). One study showed that caffeine consumption might have a relationship with breast pain (12). While earlier studies don’t confirm these findings (13), if you are suffering, might as well try it and see if it makes a difference!
- Your diet. Try upping those antioxidants and phytochemicals to support your tissues (6)! Lots of colorful fruits and veggies will do the trick. And while you’re upping the good stuff, cut back on inflammatory fats like factory farm animal products, and vegetable and soybean oils.
- Evening primrose oil. This is another one where research (14) is mixed (6), but if you are experiencing discomfort, you might as well try it! You will need to take it regularly over the course of around 6 weeks to notice an impact (6). Remember though, before you take it, talk to your health team to see if this is a good option for you. People who have epilepsy and people who are pregnant or are planning to become pregnant should avoid it (15).
- Vitamin E and B6 supplements. A study showed that Vitamin E and B6 supplements might help with breast pain, especially breast pain caused by fibrocystic changes (10,16). Heck ya to vitamins!
- Use an ice pack. Ice packs will reduce the blood flow to the area, potentially reducing inflammation and swelling (17). For a short period it can also reduce nerve activity which can help alleviate pain as well. Remember not to put the ice pack directly on the skin (use a towel!) and only do it for 10 to 15 minutes at a time (17).
- Use a hot pack or have a hot bath or shower. Not a fan of the cold? Heat can also help. By applying heat to your breasts you increase the temperature in that location, which could improve circulation and blood flow. This could soothe and relax the muscles and ease the damaged tissue (17). You can even switch between hot packs and cold packs.
- Eat less salt Part of the reason your breasts are sore in cyclical breast pain is due to water retention and swelling. Salt can make this worse (5)!
- Draining the cysts: If you have fibrocystic breast changes that don’t go away by themselves or are large and causing a lot of discomfort, your doctor can draw out the fluid using a needle or syringe. Go to your healthcare provider to discuss options (9).
But could it be cancer?
While we are used to pain = something really, really bad, breast pain actually isn’t typically the first sign of cancer (18). Generally the first symptom of breast cancer is a painless hard lump (6) (like a frozen pea), which is why it is so important to do monthly breast checks (Remember to start at the armpit! You have breast tissue there!) If you ever do find a lump, or aren’t sure, check in with your health team. And, while pain typically isn’t the first symptom, if you do have pain that is unaccounted for and not cyclical, and/or on a very specific area of your breast, always better to play it safe! Go get checked out (18)!
Written by: Martha Michaud
Medically reviewed by: Heather Bartos, MD
All content found on this Website, including: text, images, audio, or other formats, was created for informational purposes only. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.
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(2) “Breast Pain (Mastalgia).” Johns Hopkins Medicine, Based in Baltimore, Maryland. Accessed December 10, 2019. https://www.hopkinsmedicine.org/health/conditions-and-diseases/mastalgia-breast-pain.
(3) Jaime Herndon and Rachel Nall. “Breast Pain: Types, Causes, and Treatments.” Healthline. Accessed December 10, 2019. https://www.healthline.com/health/breast-pain#causes.
(4) Harvard Health Publishing. “Breast Pain: Not Just a Premenopausal Complaint.” Harvard Health. Last modified September 25, 2019. https://www.health.harvard.edu/pain/breast-pain-not-just-a-premenopausal-complaint.
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(8) “Breast Pain.” Nhs.uk. Last modified October 17, 2017. https://www.nhs.uk/conditions/breast-pain/.
(9) “Learn All About Breast Cysts.” Breast Cancer Now. Accessed December 10, 2019. https://breastcancernow.org/information-support/have-i-got-breast-cancer/breast-pain-other-benign-conditions/breast-cysts.
(10) Lori Smith, BSN, MSN, CRNP. “10 Common Causes of Breast Pain.” Medical News Today. Accessed December 10, 2019. https://www.medicalnewstoday.com/articles/311833.php#common_causes.
(11) “Fibrocystic Breasts – Symptoms and Causes.” Mayo Clinic. Last modified February 8, 2019. https://www.mayoclinic.org/diseases-conditions/fibrocystic-breasts/symptoms-causes/syc-20350438.
(12) “Factors Effecting Mastalgia.” PubMed Central (PMC). Accessed December 10, 2019. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4960349/.
(13) “A Systematic Review of Current Understanding and Management of Mastalgia.” PubMed Central (PMC). Accessed December 10, 2019. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4141056/.
(14) Pruthi S , et al. “Vitamin E and Evening Primrose Oil for Management of Cyclical Mastalgia: a Randomized Pilot Study. – PubMed – NCBI.” National Center for Biotechnology Information. Accessed December 10, 2019. https://www.ncbi.nlm.nih.gov/pubmed/20359269.
(15) Newman, Tim. “Breast Pain: Causes, Symptoms, and Treatments.” Medical News Today. Accessed December 10, 2019. https://www.medicalnewstoday.com/articles/263566.php#treatment_options.
(16) “Clinical Effectiveness of Vitamin E and Vitamin B6 for Improving Pain Severity in Cyclic Mastalgia.” PubMed Central (PMC). Last modified November 2015. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4700694/.
(17) Gotter, Ana. “Treating Pain with Heat and Cold.” Healthline. Accessed December 10, 2019. https://www.healthline.com/health/chronic-pain/treating-pain-with-heat-and-cold#applying-cold-therapy.
(18) “Breast Pain – Symptoms and Causes.” Mayo Clinic. Last modified January 31, 2019. https://www.mayoclinic.org/diseases-conditions/breast-pain/symptoms-causes/syc-20350423.